The first study of HIVers who toke finds the
weed won't mess with your meds but -- pass the brownies! -- may help
you put on the pounds.
If you've been passing on toking for fear of
taking the punch out of your protease inhibitors, the news out of the
University of California at San Francisco is good. Results from longtime
AIDS doc Don Abrams' study of marijuana's effects on protease-takers
show that cannabinoids, whether smoked as joints or swallowed in the
synthetic "pot pill" Marinol (dronabinol) don't increase viral-load
levels after three weeks of use -- sufficient time, researchers say,
to suggest long-term safety on that score. Abrams also found that both
forms lead to greater caloric intake and weight gain.
Abrams' results build on years of experience
racked up by the many positive potheads who already work the drug into
their treatment routines. HIVers proudly top the list of medical-marijuana
mavens, according to a federal Institute of Medicine report released
in March 1999. That may be because, as the document states, nausea,
appetite loss, pain and anxiety -- all aspects of AIDS wasting and drug
side effects -- can be mitigated by marijuana. Or because it's the one
treatment that's both safe and, well, fun. "Clearly, marijuana is extremely
safe over both the short and the long run," says Arnold Leff, MD, an
AIDS specialist who has had many toking patients in his 15-year practice
in -- where else? -- Santa Cruz, California. "There are some side effects
-- being stoned, feeling urinary hesitancy, fatigue or sleepiness --
but they are all minor. And the antinausea effect and increased appetite
occur at low doses. Most people develop tolerance to the side effects
without developing tolerance to the therapeutic effects."
Gary McMillin, a Santa Cruz PWA battling a 30-pound
weight loss from a staph infection, has been in recovery for more than
20 years, but brought marijuana back into his life after he saw his
lover suffer through the side effects of appetite-stimulating drugs.
"Megace [megestrol] killed his sex drive and made him so uncontrollably
hungry he would choke on food trying to get it down," he says. "Marinol
would zonk him out for hours." McMillin says his own protease-based
combo is very hard on his stomach, and pot is a remedy whose dose he
can more or less control. "By having a few puffs as I do my meds, it
settles my stomach enough to get some toast and scrambled eggs in me."
(He now grows his own and helps supply free marijuana to 300 people
with medical needs.)
According to Abrams' randomized, partially blinded,
placebo-controlled study, the herb not only helped breakfast stay down
for the 20 tokers, but also didn't counteract the drug combo by either
impairing the immune system or competing with the liver enzymes that
metabolize protease inhibitors.
On the other hand, the weed's ability to impair
short-term memory is legendary; the studies on cognitive effects over
the long haul have had contradictory results. Data on other possible
long-term risks is more sketchy. Leff, whose resumé includes a term
as deputy associate director of the White House Drug Abuse Office under
President Richard Nixon, is convinced that marijuana is safe -- except
for the tar produced through smoking, which he says might cause emphysema
if continued for years. A 1991 report in The New England Journal
of Medicine noted a relationship between fungal infections and bacterial
pneumonia in pot-smoking PWAs; cellular and molecular studies have also
suggested smoked pot could potentially cause lung cancer. (See "Safer,
Saner Weed" for safety tips.)
But the long-term trials needed to clarify pot
risks may be a long time coming, thanks to the federal "war on drugs."
Even to get medical marijuana studied for three weeks proved extremely
difficult, embroiling Abrams in a highly politicized, seven-year process
that began in 1992. Things heated up in 1996, when he and his colleagues
in a community-based trial consortium were surprised to learn that 11,000
Bay Area HIVers were getting pot from cannabis clubs. They stepped up
their efforts to get the drug studied, but were turned away by the National
Institutes of Health, which must approve studies; by the Drug Enforcement
Administration, which must approve the use of the pot; and by the National
Institute on Drug Abuse, the grower, which must release the pot. All
three agencies leveled the default claim that the science behind the
study was not good enough. Not until 1997 -- after medical marijuana
initiatives had passed in two states, and a year before initiatives
would pass in six others -- were the legal, political and scientific
Then came the challenge of finding HIVers to
endure, er, enroll in the study, which included a 21-day hospital stay
without visitors, eating hospital food and smoking three low-grade,
government-grown joints a day under a nurse's supervision -- if they
got lucky enough not to get placed in the study's Marinol or placebo
arms. "We had to screen 15 people for every person we found for the
study," Abrams says. "Most said they couldn't stop smoking for the 30
days prior to the study [a requirement of entry] because they wouldn't
be able to handle their AIDS drugs."
One person who met the challenge and is glad
to be back to his normal life is Dan Hodge, a former librarian on a
protease inhibitor-based combo. "About a half hour before meals, the
nurse would bring us an ashtray, roach clips and a lighter, and another
person in the study would join me to smoke. It was like a smoke tea
party," says Hodge. "The refrigerator was full of desserts, candy bars,
cheese and crackers, carrot sticks and yogurt." He says he gained weight
after the three weeks of reading, writing, pot-smoking and feasting.
With the study's promising preliminary results
on weight gain and caloric intake (the jury's still out on body composition),
doors may soon open for Phase II trials of the herb's effectiveness.
The investigators are welcoming the prospect. Says Abrams, who presented
the study at the International AIDS Conference in Durban in July: "No
one has ever before studied marijuana in HIV patients. We have a lot
of information we haven't yet analyzed, but everything we've seen so
far makes us excited."
SAFER, SANER WEED
Here are three tips that experts say may
help HIVers minimize some of the most
Here are three tips that experts say may
help HIVers minimize some of the most common risks associated
with chronic use of pot:
For more on how to get and use medical
marijuana, including cautions about drug laws, see "Reefer Rap"
and "Get Baked," POZ, April 1999.
- HOLD THE MOLD. Those with lowered
immunity or respiratory problems should stay away from marijuana
contaminated by mold, whose growth is spurred by the same wet
conditions that promote rot. Even baking can't render mold harmless.
Besides pot smoke from dirty bongs, the biggest source of mold
is pot that's been packed and compressed improperly (with seeds
or before it's fully dried). Tipoffs: a vinegary, ammonia-like
smell or whitish powdery spots on the herb.
- WAKE 'N BAKE. The tried-and-true
way to avoid the harms of smoke is using that old pot-brownie
recipe from high school. Keep in mind, though, that it takes longer
for digested pot to get to your bloodstream, so you may need higher
doses. And because it takes much longer to kick in, you may have
to consume it earlier.
- DON'T GET TARRED. Research has
found that bongs don't reduce the tar consumed, because water
absorbs more THC than it does tars; thus bongs require more hits
to get the same THC levels. But vaporizers -- which heat the herb
to a pre-burn and release a white cloud of medically useful cannabinoids
for inhalation -- might do the trick. Though not approved for
use with marijuana, they can, according to one study, offer less
tar than smoking. And while unavailable at WalMart, they're not
scarce: Try your local cannabis club or head shop; for general
info, log onto the Website of drug-pro Stephen John Carpenter
Meanwhile, scientists are developing other smokeless delivery
systems, including inhalers, tinctures and pills, but these must
pass FDA muster before they hit your local pharmacy. -- SG